Dyadic Coping, Psychological Flexibility, and Depression Among Couples Who Experienced Pregnancy Loss: An Actor-Partner Interdependence Mediation Model

Background and Purpose: Pregnancy loss is a significant shared stressor that places both partners at elevated risk for depression, yet the relational mechanisms through which bereaved couples navigate grief remain poorly understood. Psychological flexibility, referring to one's capacity to engage with distressing experiences in ways consistent with personal values, is well established as a protective factor against depression. Whether one partner's dyadic coping influences the other partner's psychological flexibility and, in turn, their depressive symptoms has not been examined. This study applied the Actor-Partner Interdependence Mediation Model (APIMeM) to investigate how dyadic coping relates to depression through the mediating role of psychological flexibility among couples who experienced pregnancy loss.

Methods: Participants were 246 heterosexual married couples (N = 492) residing in Hong Kong who had experienced at least one pregnancy loss. Couples were recruited through a convenience sample via NGOs and hospitals and completed an online self-report survey. Measures included the Dyadic Coping Inventory (DCI), the Patient Health Questionnaire (PHQ), and the Comprehensive Assessment of Acceptance and Commitment Therapy Processes (CompACT). Data were analyzed using the APIMeM framework in Mplus.

Results: Significant actor-mediated pathways were found for both partners. Husbands' dyadic coping positively predicted their own psychological flexibility (β = 0.31, p < .001), which in turn negatively predicted their own depressive symptoms (β = 0.48, p < .001). A parallel pathway was found for wives (β = 0.30 and β = 0.47, both p < .001). A significant cross-partner effect was also identified: husbands' psychological flexibility negatively predicted wives' depressive symptoms (β = 0.13, p < .05), suggesting that a husband's capacity for adaptive responding extends beyond his own wellbeing to protect his wife from depression following pregnancy loss. The reverse partner effect, from wives' psychological flexibility to husbands' depression, was non-significant, pointing to an asymmetric gender dynamic. Dyadic coping scores were strongly correlated between partners (r = 0.66, p < .001), and residual depressive symptoms were significantly correlated across partners (r = 0.30, p < .001), confirming couple-level interdependence.

Conclusions and Implications: Psychological flexibility serves as a within-person mediator connecting dyadic coping to depression among couples bereaved by pregnancy loss. A key finding is the unidirectional spousal effect whereby husbands' psychological flexibility predicted lower depressive symptoms in their wives, with no corresponding effect in the reverse direction. This asymmetric pattern reflects gendered grief processes in which wives experiencing pregnancy loss often face greater social pressure and emotional isolation. For social work practice, these findings support engaging husbands as active participants in couple-focused bereavement services rather than treating them as secondary supports. ACT-informed interventions that strengthen psychological flexibility in both partners hold promise for hospital and NGO-based post-loss programs. The within-couple covariance in dyadic coping and depressive symptoms further supports the use of dyadic rather than individual intervention models. Future research should use longitudinal designs to clarify causal pathways and evaluate culturally responsive dyadic ACT programs for bereaved couples.